GENERAL SUMMARY:

Under the direction of the Director, of Financial Clearance, the Financial Clearance Rep is responsible for ensuring accounts are financially cleared prior to the date of service. Financial Clearance Reps are responsible for interviewing patients when they are scheduled to come into the hospital either for an elective outpatient, scheduled surgery or outpatient procedure.

ESSENTIAL DUTIES:

1. Perform all Financial Clearance duties to ensure the account is financially cleared prior to service. The Financial Clearance Rep is responsible for gathering demographic information (i.e. name, address, phone number, social security number, type of insurance coverage, etc.) about the patient. This key position begins the overall patient's experience and starts the billing process for any services provided by the hospital. This position is responsible for obtaining and verifying accurate insurance information, benefit validation, authorization and pre-service collections.

2. Financially clears patients for each visit type, admit type and area of service via EPIC (Electronic Medical Record- EMR). Collects and documents all required demographic and financial information. Appropriately activates registration and discharges in a timely fashion.

3. Accurately and efficiently performs registration and financial functions to include: thorough interviewing techniques, pre-registers patients in appropriate status, follows pre-registration guidelines while ensuring the accurate and timely documentation of demographic and financial data. Analyze patient insurance(s), identifies the correct insurance plan, selects appropriately from EPIC insurance and plan selections and documents correct insurance order. Applies recurring visit processing according to protocol. May facilitate use of electronic registration tools where available (credit card processing, etc.).

4. Verifies patient information with third party payers. Collects insurance referrals and documents within EPIC. Communicates with patients and physician/offices regarding authorization/referral requirements. Obtains financial responsibility forms or completed electronic forms with patients as necessary.

5. Screens outpatient visits for medical necessity. Provides cost estimates. Collects and documents Medicare Questionnaire and obtains information from the patient if third party payers need to be billed (i.e. worker's compensation, motor vehicle accidents and any other applicable payer). Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans. Ensures Meaningful Use requirements are met as appropriate.

6. Financial Advocacy: Screens all patients self-pay & out of network patients using approved technology. Provides information for follow up and referral to the Benefit Advisor as appropriate. Initiates payment plans and obtains payment. Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family. Incorporates point of service (POS) collection processes into daily functions.

7. Collects CPT and ICD-10 codes. Performs medical necessity check and prepares ABN as appropriate for Medicare primary outpatients.

8. Manages/prepares miscellaneous reports, schedules and paperwork. Maintains inventory of supplies.

9. Maintains and exceeds the department specific individual productivity standards, collection targets, quality audit scores for accuracy productivity, collection and standards for registrations/insurance verification.

This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.

STANDARD REQUIREMENTS:

1. Supports the Mission, Value and Vision of Beaumont Health (BH). Demonstrates personal commitment through active involvement in the performance improvement processes.

2. Exhibits excellent customer service skills and behaviors toward internal and external customers and co-workers. Promotes positive public relations with patients/residents, family members, guests, and others.

3. Supports and adheres to all Beaumont Health’s customer service, service excellence and performance standards. Supports and participates with all required compliance standards that may be department specific and/or identified by the organizations including in-service training, acceptable attendance, uniform and dress code.

4. Adheres to HIPAA requirements and maintains confidentiality of all data, including patient/resident, employee and operations information.

5. Supports and participates in a collaborative team oriented environment – cooperates and works together with all co-workers, payers and completes job duties. Uses appropriate communications in sensitive and emotional situations and follows up as needed regarding reported complaints, problems and concerns.

6. Supports, cooperates with and demonstrates safe work practices and attitudes. Follows safety rules – including universal precautions – reports and prevents/corrects unsafe conditions and behaviors, and participates in organizational and departmental safety programs.

7. Completes all required compliance standards that may be department specific and/or identified by the organization.

8. Maintains current licensure, registration and/or certification, as applicable, at all times.

STANDARD QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. The majority of time in this position is performed in a call center environment with telephone call interactions with patients and payers. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

A. Education / Training:

• High school diploma or equivalent required.

• Associate or bachelor's degree in business, management or other related fields preferred.

B. Work Experience:

• 1 year experience preferred in a customer service role or health care industry.

C. Certification, Licensure, Registration:

The department will provide education and training thru HFMA (Healthcare Financial Management Association). As an employee of the revenue cycle department the expectation is to obtain CRCR (Certified Revenue Cycle Representative) certification within 1 year of joining the department.

D. Other Qualifications:

• Working knowledge of Windows, Excel, Word, Outlook, EPIC, Electronic Eligibility System and various websites for third party payers for verification is preferred.

• Must be able to accurately manage a great number of details in a fast paced, dynamic environment while providing excellent service to Beaumont’s patients, visitors, clinical departments & physicians.

• Excellent, demonstrated, customer service & communication skills required.

• Demonstrates problem solving, organization, judgment, and diplomacy and multi-tasking skills are necessary.

• Ability to work independently and supervise individual workload to meet targets and productivity standard along with a varied schedule.

• Beaumont Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.